2015 Report on Tuberculosis Research Funding Trends, 2005–2014: A Decade of Data

Working in tuberculosis (TB) research has long meant laboring with too little and waiting for what comes too late. In recent years, an emergent optimism has crept into TB research, but too often the individuals and institutions that comprise the TB research field find their good ideas and energy put on hold by insufficient funding. Ten years of data collected by Treatment Action Group (TAG) show that funding shortfalls for TB research and development (R&D) are serious and chronic. The modest gains in TB research funding from 2005 to 2009 have stagnated in the five years since, and total funding for TB R&D has never exceeded $700 million per year. Throughout the 2005–2014 period, over half of TB research funding has come from public institutions, with a significant decline in industry investment and little growth or increased diversity in philanthropic support. This trend continued in 2014, when funding for TB R&D totaled $674.0 million, 62 percent of it from public agencies. This lack of funding has left TB researchers waiting for the resources required to put new ideas to the test and now threatens to forestall the TB community’s ambitious vision for the future: a world free of TB.

TAG has tracked global spending on TB R&D each year since 2005, measuring actual funding levels against the targets set forth in the Stop TB Partnership’s Global Plan to Stop TB. The situation in 2014, our 10th year of data collection, looks much as it did in 2009. In that year, funding for TB R&D crossed the $500 million mark for the first time, reaching $636.9 million, a jump of 29 percent from the $494.6 million spent in 2008. This sizeable increase came from a single source (the United States government) responding to an emergency (the global financial crisis) with exceptional measures (stimulus money). By lifting the budget of the U.S. National Institutes of Health (NIH), U.S. stimulus spending under the American Recovery and Reinvestment Act set a benchmark that TB research has maintained in the years since 2009. But the field has not pushed past this mark to reach the higher levels of funding required to achieve transformational science. Instead, in 2014, total TB R&D spending of $674.0 million left a funding gap of $1.3 billion measured against the $2 billion annual investment experts called for in the Global Plan to Stop TB 2011–2015. Funding shortfalls persist in every category of research tracked by TAG—from basic science, to the development of new diagnostics, drugs, and vaccines, to operational research on their delivery and implementation.

As this decade of missed targets closes, researchers are still waiting for the funding that never arrived. During this wait, people with TB—and their families, caregivers, and communities—are left to face the epidemic without the new drugs, drug regimens, diagnostic tests, and vaccines necessary to end it. The present moment is one that invites reflection, not just backward in time, where missed opportunities and lost lives cast long shadows, but also forward into the next decade, where new aspirations light the horizon.

And the horizon is close. Within the TB field, the World Health Organization’s (WHO’s) End TB Strategy has set an ambitious goal of eliminating TB by 2035 by reducing TB deaths by 95 percent and new cases of TB by 90 percent compared with 2015 levels. The Stop TB Partnership’s revised Global Plan to Stop TB, 2016–2020 maps out what the global community must do within the next five years to eliminate TB. Within the larger global health arena, the Millennium Development Goals (MDGs) are giving way to the Sustainable Development Goals (SDGs), with their dense forest of 17 goals and 169 targets. In the MDGs, TB was relegated to the catchall category of “other diseases” and not named alongside HIV and malaria in the title of MDG 6. The specific mention of TB with HIV and malaria in SDG 3 offers hope that the most lethal pathogenic killer in human history will finally garner the political attention that it deserves. Despite TB’s resurgence alongside the HIV epidemic in the 1990s, and its stubborn persistence in the first 15 years of the twenty-first century, TB has never summoned the political will, financial investment, and scientific energy equal to its outsized toll on human health and well-being. This must change for the next decade to avoid a dismal resemblance to the last.

It is imperative to break out of this stagnation in funding, political commitment, and popular attention to go somewhere new in our response to TB. Repetition of past failures holds a firm and frustrating grip on the fight against TB. The pathogenesis of TB itself is often repetitious in the way it can relapse into active disease in people with TB infection and reinfect people who have completed TB treatment and been declared cured. Similar phenomena characterize the human response to TB, not just inside the body at the level where human host and TB pathogen interact but also at the collective level of the body politic. A recent history of the response to TB in the twentieth century by Christian McMillan titled Discovering Tuberculosis details the ways in which each generation of scientists and policy makers has rediscovered TB as if for the first time. This cycle includes relearning qualities of TB biology and epidemiology discovered in earlier times but now forgotten. Given this history, the question hanging over the next decade of TB research is: will we repeat the missteps of the last 10 years and excuse ourselves by claiming that we are learning something new?

Even with the inadequate funding of the past five years—only $2.7 billion of the $9.8 billion called for—TB researchers managed to (re)learn many things about TB biology, develop two new drugs against drug-resistant TB, approve a shorter regimen to treat TB infection, introduce a more rapid diagnostic test, and reinvigorate the once-dormant field of TB vaccine research. As we imagine the next 10 years, there is an urgent need to remember what we learned from the last decade and to let this memory spur us to secure the funding, political will, and public pressure that can prevent us from repeating past mistakes.